People with epilepsy have increased risk of premature death, and their life expectancy may reduce by 2-10 yr. Population- and hospital-based studies have shown that the excess mortality in epilepsy is not entirely explained by deaths directly attributable to epilepsy such as accidents and drowning during a seizure. It is also significantly contributed by deaths from other causes such as cardiac deaths, deaths due to malignancies and other causes. It had recently been recognized that sudden unexpected deaths in epilepsy (SUDEP) contributed to a small yet important proportion of mortality in epilepsy. SUDEPs are deaths (witnessed or unwitnessed) unrelated to trauma, drowning or status epilepticus and not attributable to any specific medical conditions. Several factors related to epilepsy and drug therapy have been found to be associated with higher risk of SUDEP.
Melioidosis which is endemic in South East Asia and Northern Australia is now being reported from the Indian subcontinents as well. Meliodosis rarely presents as pericardial effusion. We report a case of B. pseudomallei causing pericardial effusion from India, where the most common infective cause of pericardial effusion is Mycobacterium tuberculosis. The chronic presentation of melioidosis is not unlike tuberculosis, and the clinician must have a high index of suspicion to diagnose meliodosis, especially in geographical areas where both tuberculosis and melioidosis are prevalent.DOI: http://dx.doi.org/10.3329/jom.v13i2.9368 J Medicine 2012; 13 : 230-232
Cardiovascular autonomic nervous dysfunction has been demonstrated to severely debilitate HIV infected patients, namely by postural hypotension and syncopes. It has important implication in health care of HIV patients. Presence of autonomic neuropathy signals the need for added precautions when invasive procedures are performed on HIV patients.
Background: NMDA receptor encephalitis (NMDARE) is the most prevalent autoimmune encephalitis and it encompasses a spectrum of clinical features. It is most commonly associated with alteration in consciousness, seizures, neuro-psychiatric symptoms, and movement disorders. Electroencephalography (EEG) plays a vital role and can give clues to diagnosis in a subset of patients. Methods: We retrospectively characterized the clinical and EEG findings in our NMDARE patients (n = 48). A total of 131 EEGs were analyzed. Results: We observed that patients with seizures had a younger age of onset (p < 0.001). The most common EEG pattern that was noted was diffuse slowing (n = 20) followed by generalized rhythmic delta activity (n = 9), focal spikes and slowing (n = 8 each). Delta brush pattern was seen in only 3 EEGs. Focal ictal rhythms were seen in 3 EEGs. There was no significant difference in outcomes such as seizure recurrence, modified Rankin score (mRS) at follow up/discharge or relapse between groups of patients who had EEG abnormalities in the first EEG and with those who did not. Conclusions: NMDARE has varied EEG findings, most of them being non-specific. When combined with clinical presentation, EEG is a useful tool in the diagnosis and management of NMDARE.
Introduction:CML is the commonest haematological malignancy encountered in clinical practice; and known for its variability in presentation 1 . Spontaneous hematomas are not a usual presenting symptom of CML 2, 3, 4 . We noted a few reports of CML presenting with intra muscular and neuro-hematomas in the review of literature. We report, spontaneous chest wall hematoma as an uncommon presenting symptom of CML. Case Report:A 45 year old male, presented to the emergency department, with complaint of sudden swelling over the left chest wall (infra axillary area) on lifting a heavy object. The swelling was painfull and boggy to feel (figure-1). There was history of trauma redness around the area prior to its formation. On examination, he was pale, the vital signs were normal. The swelling was warm to touch, soft and fluctuant, and was tender to palpate. He had a huge, firm, non-tender splenomegaly. He had sternal tenderness; and had no purpura, petechiae, ecchymosis, or other swelling on his body. Other system examinations including fundoscopy were normal.On investigations: Haemoglobin -5.2 g%, total WBC count -2,99,000/mm 3 [differential count -Neutrophils-45, Lymphocytes-4, Eosinophils-3, Basophils-2, Blasts-2, Promyelocytes-2, myelocytes-18, metacymyelocytes-9, band forms-15]; n RBC/ 100WBC -07/WBC; ESR-125 mm/hr; Platelets-232,000/mm 3 . This blood smear was suggestive of CML in chronic phase. Liver and renal functions tests; PT, APTT, BT and CT were normal. Sr LDH was 1023 IU/ l and Sr uric acid was 11.7 mg %. Chest x ray showed homogenous opacity in the left mid and lower zones. Sonography of chest wall showed hypoechoic area within the muscles in the infra- Spontaneous Chest Wall Hematoma -Unusual Presentation of Chronic Myeloid Leukemia
Aim:The aim is to study survival outcome and sudden unexpected death in epilepsy (SUDEP) of people with epilepsy who underwent epilepsy monitoring.Subjects and Methods:Between 2000 and 2004, 558 persons were admitted to the epilepsy monitoring unit of SCTIMST who fulfilled the selection criteria. Their survival status as on December 31, 2013, was ascertained by clinic attendance record and by mail or telephone contact.Results:Five hundred and fifty-eight persons with epilepsy (males 319, 6408 person-years) were included in this study. There had been 20 deaths till December 31, 2013, and 5 additional deaths were reported when followed up till May 2016. The standardized mortality ratio was 5.35 and higher for males (6.25) than for females (3.52). Those with generalized seizures (tonic and myoclonic seizures), electroencephalography (EEG) showing multifocal and generalized interictal discharges, and polypharmacy had a higher risk of mortality. SUDEP accounted for 5 deaths.Conclusion:People with refractory epilepsy who had undergone presurgical video EEG monitoring had higher mortality risk. Generalized or myoclonic seizures, multifocal or generalized interictal discharges, and polypharmacy independently increased their risk of mortality. SUDEP is an important cause of death.
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